TSR Med Students&#x27; Society Part III

Original post by Tech

also, I know it's not part of our curriculum for phase 1 that we learn how to take histories and that kind of thing - but I think that's part of the whole reason we've got doctors to take us for PDS.

I've learnt a lot of clinical stuff from my tutor, like how to take a real history and how to write a real referral letter (not just the portfolio box-ticking ones) from just using the opportunity to ask a doctor.

but if PDS goes then so much for that! =\

Did you ever get my PDS guide, as a side note? I'm not sure my account is working. I don't think the other guy got it.

Reply 2522

digitalis

Original post by Jessaay!

I agree. No doubt I'll **** up when I get to clinics at various points, but I will definitely learn. That and we have done brief "clinical skills" sessions in first year so far... went straight over my head, didn't know what I was doing and don't feel any more prepared to do any sort of examinations on patients and don't know what the hell they're for... but I will be in a better position to know when I get there, and there's a huge likelihood that even if I did understand first time round I'd forget it all anyway by the time I get to clinical years :p:

Yeah, this is normal :smile:

You won't have a scooby doo what your doing initially. I remember in first year we had to memorise full cardio/resp/abdo/periph neuro exams for our OSCEs. So this farcical scene would be played in exam booths all over where freshers would be churning out "I'm looking for palmar erythema, Dupuytren's contractures, koilonychia" etc without knowing what any of these were. Complete waste of effort and a sole exercise in memorisation. More painful was these counted for 50% of our grades.

Third year you will quickly pick up basic signs, just by the fact that you will be seeing large volumes of patients every day on the ward round (say 15-20 a day) and you can identify who's sick, who's jaundiced, who has pallor etc. You will be surprised by how much you know at the end of third year! :smile:

Reply 2523

Tech

Original post by Jessaay!

Did you ever get my PDS guide, as a side note? I'm not sure my account is working. I don't think the other guy got it.

ah bless you for sending it :smile:

I didn't get it though, no worries! I know a few people who have copies but most of them are in israel this week, I'll grab it then... not properly starting PDS revision for a couple of weeks yet :smile:

Reply 2524

Philosoraptor

18

Original post by Tech

ah bless you for sending it :smile:

I didn't get it though, no worries! I know a few people who have copies but most of them are in israel this week, I'll grab it then... not properly starting PDS revision for a couple of weeks yet :smile:

Well on that note - I was lucky and had a GP for both years of PDS - but plenty of people don't have doctors for PDS...

Reply 2525

Tech

Original post by Philosoraptor

Well on that note - I was lucky and had a GP for both years of PDS - but plenty of people don't have doctors for PDS...

ah of course - all but one of of the groups at the free this year have doctors, so I assumed it was the norm to have a doctor... the people who don't would be at a considerable disadvantage there.

Reply 2526

Jessaay!

My PDS tutor was astoundingly awesome. Took us out to Pizza express at the end of the year and paid for it all. He also gave a lot of moral support which I think they should do, and as soon as I failed my exams gave me a call to make sure I was OK and talk me through my options. He was also very forgiving for the fact I always turned up hungover without fail and actually I think he respected me for it :p:

Reply 2527

Jessaay!

Original post by Tech

ah bless you for sending it :smile:

I didn't get it though, no worries! I know a few people who have copies but most of them are in israel this week, I'll grab it then... not properly starting PDS revision for a couple of weeks yet :smile:

It's entirely possible I was being a complete retard. If it's not there this time I'm at a loss to what I'm doing, but I tried again :p:

Reply 2528

Becca-Sarah

19

Original post by Philosoraptor

Should havecome to the AGM haha.

Basically your clinical modules are getting mixed around a bit - and your 4th year will be one exam right at the end.
So 4th year will no longer be just the specialities. [My year next year will be the last year with just specialities and the exams every 12 weeks].
And as you already know 3rd year BSc compulsory, but more integrated to the rest of the course rather than being like a year out etc

Ah, that would explain why they're not letting externals in anymore. I feel marginally less bitter now.

Reply 2529

Kinkerz

Original post by Jessaay!

I don't think good communication is underestimated at all even with traditional preclinical courses.

I mean amongst students. I felt similarly blasé about preclinical exposure to patients until I actually experienced what it was like to be a patient with a doctor who couldn't communicate well.

However, yes some people in a traditional course will be utter ****e at communication even when they get to clinics but I think that's a rarity. We're still taught about "good communication" and whilst we may not be AS prepared as someone who's been frequently exposed to patients since term 1, I think it is possible to catch up quite quickly (depending on the person, of course). I don't think it means that our med schools undervalue good communication, or they don't prepare us for clinics. Maybe clinics will be a bit more of a shock for us but for what we don't initially know in terms of communication and clinical skills we can make up for in our science and maybe in a way the science does actually help us learn about it quite quickly (that, and the added maturity of a few years, and also being constantly whined at by our PDS tutors about "good communication" and "empathy", starts to stick after a while).

It's not as if it's 'good communication or good understanding of science'. I genuinely think the disparity in terms of science isn't as great as people might think. I also think that good clinical skills are more difficult to acquire than the knowledge... science is the easy bit as far as I'm concerned.

Either way, I'm not really talking of course layouts, I'm more talking about attitudes amongst students.

Original post by digitalis

Yeah, that's what you are lead to believe...

The thing is, the amount of exposure you get to patients is huge as a clinical student. All you have to do is look at the Oxbridge transfers to discount the argument of early patient contact making better doctors. I saw a girl in my first firm progress from putting her tubes in the wrong way around and couldn't take a BP to being an amazing student and winning our first firm "Mars bar award" from the HOs for being the best medical student (obvs I joint won that one :colone:

)

I'm not saying people won't catch up. I just think it's useful for students to be exposed to patients prior to clinical years, despite not necessarily knowing much clinical medicine. Preclinical exposure isn't about the science. It's about building communication and clinical skills. I know these can be acquired later on in the course, but it's hardly a bad thing to have an idea earlier on. It doesn't really get in the way.

Also, that student may well have had more knowledge at the time; how much do you think she remembers of the minutiae of anatomy etc. she was taught?

Also, people underestimate how much people want doctors to know their ****...

Why has this turned into a "preclinical exposure = cushy doctor knows no science vs. clinical exposure = brilliantly rounded doctor with excellent communication skills and a vast knowledge of medical sciences"?

It doesn't really work like that, as I'm sure you well know. I would look with scepticism if someone at a more scientifically orientated school (other than Oxbridge) claimed to understand and know lots more science than I do and I'm sure the communication and clinical skills will balance out after the duration of the course too.

(edited 13 years ago)

Reply 2530

It could be lupus

Original post by Kinkerz

I mean amongst students. I felt similarly blasé about preclinical exposure to patients until I actually experienced what it was like to be a patient with a doctor who couldn't communicate well.

You are going to get people who can't communicate well at any place. To brand all people at traditional courses as people who wont be as good at communicating is not fair at all. The vast majority of us are equally as good as those at non-traditional courses. Its not exactly hard to engage a patient and take a history etc

Original post by Kinkerz

It's not as if it's 'good communication or good understanding of science'. I genuinely think the disparity in terms of science isn't as great as people might think. I also think that good clinical skills are more difficult to acquire than the knowledge... science is the easy bit as far as I'm concerned.

If you seen the level of detail in science I had remember, with the dozens (if not about 100) drugs that are no longer of use, then you would not say that it was easy. In fact if the science is easy, I am dreading clinical school

Original post by Kinkerz

Also, that student may well have had more knowledge at the time; how much do you think she remembers of the minutiae of anatomy etc. she was taught?

You would be very surprised. It does help the understanding of diseases and so allows the person to think of a treatment plan from first principles. Also is very useful to think of more non-conventional ways of treating people and so can be very useful for clinical research

Reply 2531

Kinkerz

Original post by It could be lupus

You are going to get people who can't communicate well at any place. To brand all people at traditional courses as people who wont be as good at communicating is not fair at all. The vast majority of us are equally as good as those at non-traditional courses. Its not exactly hard to engage a patient and take a history etc

I'm not branding all people on traditional courses as anything. If you read my post properly, you'd see that I said that I'm sure things balance out in the end. But to reiterate: as second years, I imagine that people on 'non-traditional' courses are the better communicators, but by the end of the course, I'm sure it balances out.

If you seen the level of detail in science I had remember, with the dozens (if not about 100) drugs that are no longer of use, then you would not say that it was easy. In fact if the science is easy, I am dreading clinical school

Congratulations? Doesn't sound particularly high-yield to me. I'd prefer to have that replaced with early exposure to clinical and communication skills personally.

You would be very surprised. It does help the understanding of diseases and so allows the person to think of a treatment plan from first principles. Also is very useful to think of more non-conventional ways of treating people and so can be very useful for clinical research

Learning relevant science allows the person to think of a treatment plan from first principles. I don't see how not being on a traditional course rules that out.

Reply 2532

Philosoraptor

18

Original post by Becca-Sarah

Ah, that would explain why they're not letting externals in anymore. I feel marginally less bitter now.

Yeah now I understand why they stopped letting people doing BSc after 1st year clinics (This year was the last year) and the externals thing...

Reply 2533

It could be lupus

Original post by Kinkerz

I'm not branding all people on traditional courses as anything. If you read my post properly, you'd see that I said that I'm sure things balance out in the end. But to reiterate: as second years, I imagine that people on 'non-traditional' courses are the better communicators, but by the end of the course, I'm sure it balances out.

The thing is, is communication really something that can be taught? A lot of it is whether you are naturally good with people or not... I think one of the only key things you really can be taught is what to remember to ask taking a patients history. If anything, those people who are socially awkward will always struggle with the communication thing as its just not what they like/are good at.

Original post by Kinkerz

Congratulations? Doesn't sound particularly high-yield to me. I'd prefer to have that replaced with early exposure to clinical and communication skills personally.

I never asked for congratulations. All I said is you cannot say learning science is easy...

Original post by Kinkerz

Learning relevant science allows the person to think of a treatment plan from first principles. I don't see how not being on a traditional course rules that out.

Talking to quite a few of my friends at non-traditional courses, they really dont understand the mechanisms of diseases or the science lying behind it. Instead they just not x disease can be treated with y which has (insert side effects here) side effects. Thats not exactly deriving a treatment plan from first principles...

Reply 2534

digitalis

Original post by Kinkerz

I'm not saying people won't catch up. I just think it's useful for students to be exposed to patients prior to clinical years, despite not necessarily knowing much clinical medicine. Preclinical exposure isn't about the science. It's about building communication and clinical skills. I know these can be acquired later on in the course, but it's hardly a bad thing to have an idea earlier on. It doesn't really get in the way..

See, this is my point. Preclinical years ARE about the science, not about building communication skills. And as for building clinical skills, that is the point of clinical years! You are supposed to be learning about how the body works and how it goes wrong in the first two years, so you are able to apply that knowledge to real patients when you start clinical years. All this "early exposure" stuff does actually get in the way...firstly to yourself in terms of education time and secondly think of the amount of time and money doing this stuff could be put towards something else. For example at Barts, the anatomy budget was made to suffer at the expense of MedSoc, which is extremely expensive to run and requires huge amounts of coordination (GPs don't take first years on for fun). Secondly, first and second years do get in the way of the doctors and hospital staff, they literally have to be babysat. All medical students get in the way somewhat (SIFT funding=compensation for med student time wasting) but first and second years who have so little exposure obviously need much more care and attention.

It is a sad state of affairs that there is almost a sense of 'medical indoctrination' going on at medical schools here. Thanks to Tomorrow's Doctors, we are lead to believe that PBL based, early clinical contact, communication skills fannying around is the way forward. Only now are things starting to get normalised, with more basic science being taught again.

I thought exactly the same as you when I was in my first year, but then being ritually embarrassed at my lack of knowledge infront of consultants about the most basic of anatomy questions or cell biology (how does insulin work...errrr....) thanks to our anatomy sessions involving copying down bits of paper into a workbook, or having one hour lectures on gluconeogenesis made me think otherwise.

Two 'crimes' that I can't forgive BL for in terms of wasted educational opportunities were:

1.) Having FIFTY percent of my first year graded on clinical examination and useless communication skills such as leading a blind person. I should have been tested on my basic sciences, rather than rote learning about listening for mitral regurg when I couldn't even tell you a few reasons why the valve would become incompetent.

2.) EIGHT weeks of communication and clinical skills, flanked by the christmas and easter holidays in the middle of third year. Great for the students who all buggered off on holiday, but that was the equivalent of an entire firm lost to be replaced with a women parroting on about the correct way to nod and say "mmm" EMPathetically. Much better to see it being done in real life on a ward, practice it yourself and learn some real medicine alongside it to boot.

(edited 13 years ago)

Reply 2535

Mushi_master

Out of curiosity, what are these changes with the UCL course?

Reply 2536

Kinkerz

Original post by It could be lupus

The thing is, is communication really something that can be taught? A lot of it is whether you are naturally good with people or not... I think one of the only key things you really can be taught is what to remember to ask taking a patients history. If anything, those people who are socially awkward will always struggle with the communication thing as its just not what they like/are good at.

They are something that can be taught. But that's not the point. Early experience with patients allows you to build your skills in talking to them, regardless of whether you're naturally gifted at it or not. It's not being taught per se, it's learning through experiences.

I never asked for congratulations. All I said is you cannot say learning science is easy...

I didn't mean that it is easy, I just think it's easier to master than the clinical aspects of medicine.

Talking to quite a few of my friends at non-traditional courses, they really dont understand the mechanisms of diseases or the science lying behind it. Instead they just not x disease can be treated with y which has (insert side effects here) side effects. Thats not exactly deriving a treatment plan from first principles...

I agree with you to some degree. I imagine a reasonable portion of my cohort are going to graduate not knowing much regarding underlying principles, but I suspect by the time a lot of people graduate (including many from 'traditional' or what people might consider 'non-fluffy schools'), they won't know that much about the basic science*... memory, unfortunately, isn't perfect. Either way, I don't think any lack of science is due to early patient exposure!

*I don't know about other schools, but clinicians we get taught by have largely forgotten their basic sciences (having been through traditional courses...).

Original post by digitalis

See, this is my point. Preclinical years ARE about the science, not about building communication skills.

All of medical school should be about building communication skills and including those in the first few years doesn't impinge upon science.

And as for building clinical skills, that is the point of clinical years! You are supposed to be learning about how the body works and how it goes wrong in the first two years, so you are able to apply that knowledge to real patients when you start clinical years.

I don't think there should be such a divide. I don't see the problem with fusing the basic science with clinical skills.

All this "early exposure" stuff does actually get in the way...firstly to yourself in terms of education time and secondly think of the amount of time and money doing this stuff could be put towards something else. For example at Barts, the anatomy budget was made to suffer at the expense of MedSoc, which is extremely expensive to run and requires huge amounts of coordination (GPs don't take first years on for fun). Secondly, first and second years do get in the way of the doctors and hospital staff, they literally have to be babysat. All medical students get in the way somewhat (SIFT funding=compensation for med student time wasting) but first and second years who have so little exposure obviously need much more care and attention.

Fair points. I don't know how much significance that holds broadly across all 'fluffy' schools.

It is a sad state of affairs that there is almost a sense of 'medical indoctrination' going on at medical schools here. Thanks to Tomorrow's Doctors, we are lead to believe that PBL based, early clinical contact, communication skills fannying around is the way forward. Only now are things starting to get normalised, with more basic science being taught again.

I don't think it's indoctrination. During my first year I thought precisely like you do. A lot of my fellow students feel like you do. I changed my mind after experiencing healthcare from a patient's perspective and having to put up with staff with ****e communication skills.

I thought exactly the same as you when I was in my first year, but then being ritually embarrassed at my lack of knowledge infront of consultants about the most basic of anatomy questions or cell biology (how does insulin work...errrr....) thanks to our anatomy sessions involving copying down bits of paper into a workbook, or having one hour lectures on gluconeogenesis made me think otherwise.

I guess after next year I might change my mind. I don't know, but at this point I have little problem with early clinical exposure. I can see I'm in the minority here though.

(edited 13 years ago)

Reply 2537

digitalis

Original post by Kinkerz

..

I don't think it's all doom and gloom though. It is certainly motivational and makes you feel like a 'proper medical student' and realise that what you are learning about actually has some importance.

Reply 2538

visesh